肯尼亚15至49岁痰涂片阳性肺结核患者治疗结果的性别差异。

Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya.

作者信息

Kosgei R J, Sitienei J K, Kipruto H, Kimenye K, Gathara D, Odawa F X, Gichangi P, Callens S, Temmerman M, Sitienei J C, Kihara A-B, Carter E-J

机构信息

Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.

Ministry of Health, Department of Disease Prevention and Control, Nairobi, Kenya; Moi University Department of Epidemiology, Nairobi Campus, Nairobi, Kenya.

出版信息

Int J Tuberc Lung Dis. 2015 Oct;19(10):1176-81. doi: 10.5588/ijtld.15.0070.

DOI:10.5588/ijtld.15.0070

PMID:26459529

Abstract

OBJECTIVE

To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya.

DESIGN

Retrospective descriptive cohort.

RESULTS

Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P < 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P < 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461).

CONCLUSION

Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes.

摘要

目的

确定肯尼亚15至49岁涂片阳性肺结核（PTB）患者治疗结果的性别差异以及与不良结果相关的因素。

设计

回顾性描述性队列研究。

结果

在分析的16056名受试者中，38%为女性，62%为男性。女性治疗结果不佳的风险高于男性（12%对10%，P<0.001；调整后的OR为1.29，95%CI为1.16 - 1.44，P<0.001）。在第一个多变量模型中，将分析限制在人类免疫缺陷病毒（HIV）阳性患者，并对危险因素和聚类进行调整后，女性不良结果的风险无显著降低（OR为0.99，95%CI为0.86 - 1.13，P = 0.844）。在仅限于HIV阴性患者的模型中，发现风险无显著降低（OR为0.89，95%CI为0.73 - 1.09，P = 0.267）。在第二个模型中，将分析限制在接受抗逆转录病毒治疗（ART）的患者，并对危险因素和聚类进行调整后，女性PTB治疗结果不佳的风险无显著降低（OR为0.98，95%CI为0.84 - 1.14，P = 0.792）。在仅限于未接受ART的HIV阳性患者的模型中，发现风险无显著升高（OR为1.15，95%CI为0.79 - 1.67，P = 0.461）。